Other Resources

multiple personality disorder
[dissociative identity
disorder]

....students often ask me whether
multiple personality disorder (MPD) really exists. I usually reply that
the symptoms attributed to it are as genuine as hysterical paralysis and
seizures....
--Dr. Paul McHugh

Multiple personality disorder (MPD) is a psychiatric disorder characterized
by having at least one "alter" personality that controls behavior. The
"alters" are said to occur spontaneously and involuntarily, and function more or
less independently of each other. The unity of consciousness, by which we identify our
selves, is said to be absent in MPD. Another symptom of MPD is significant amnesia which
can't be explained by ordinary forgetfulness. In 1994, the American
Psychiatric Association's DSM-IV replaced the designation
of MPD with DID: dissociative identity disorder.
The label may have changed, but the list of symptoms remained essentially
the same.

Memory and other aspects of consciousness are said to be divided up among
"alters" in the MPD. The number of "alters" identified by various
therapists ranges from several to tens to hundreds. There are even some reports of several
thousand identities dwelling in one person. There does not seem to be any consensus among
therapists as to what an "alter" is. Yet, there is general
agreement that the cause of MPD is repressed memories of childhood sexual abuse. The
evidence for this claim has been challenged, however, and there are very few
reported cases of MPD
afflicting children.

Psychologist Nicholas P. Spanos argues that repressed memories of childhood abuse and
multiple personality disorder are "rule-governed social constructions established,
legitimated, and maintained through social interaction." In short, Spanos argues that
most cases of MPD have been created by therapists with the cooperation of their patients and the rest of
society. The experts have created both the disease and the cure. This does
not mean that MPD does not exist, but that its origin and development are
often, if not most often, explicable without the model of separate but
permeable ego-states or "alters" arising out of the ashes of a
destroyed "original self."

A rather common view of MPD is given by philosopher Daniel Dennett.

...the evidence is now voluminous that there are not a handful or a hundred but
thousands ofcases of MPD diagnosed today, and it almost invariably owes its
existence to prolonged earlychildhood abuse, usually sexual, and of sickening
severity. Nicholas Humphrey and Iinvestigated MPD several years ago
["Speaking for Our Selves: An Assessment of MultiplePersonality
Disorder," Raritan, 9, pp. 68-98] and found it to be a complex phenomenon thatextends far beyond individual brains and the sufferers.

These children have often been kept in such extraordinary terrifying and confusing
circumstances that I am more amazed that they survive psychologically at all than I am
thatthey manage to preserve themselves by a desperate redrawing of their
boundaries. What they do, when confronted with overwhelming conflict and pain, is this:
They "leave." They create aboundary so that the horror doesn't happen to
them; it either happens to no one, or to someother self, better able to sustain
its organization under such an onslaught--at least that's whatthey say they did,
as best they recall.

Dennett exhibits minimal skepticism about the truth of the MPD accounts, and focuses on
how they can be explained metaphysically and biologically. For all his brilliant
exploration of the concept of the self, the one perspective he doesn't seem to give much
weight to is the one Spanos takes: that the self and the multiple selves of the MPD
patient are social constructs, not needing a metaphysical or biological explanation so
much as a social-psychological one. That is not to say that our biology is not a
significant determining factor in the development of our ideas about selves, including our
own self. It is to say, however, that before we go off worrying about how to
metaphysically explain one or a hundred selves in one body, or one self in a hundred
bodies, we might want to consider that a phenomenological analysis of behavior which takes
that behavior at face value, or which attributes it to nothing but brain structure and
biochemistry, may be missing the most significant element in the creation of the self: the
sociocognitive context in which our ideas of self, disease, personality, memory, etc.,
emerge. Being a social construct does not make the self any less real, by
the way. And Spanos should not be taken to deny either that the self
exists or that MPD exists.

But if thinkers of Dennett's stature accept MPD as something which needs explaining
in terms of psychological dynamics limited to the psyche of the abused rather than
in terms of social constructs, the task of convincing therapists who treat MPD to
accept Spanos' way of thinking is Herculean. How could it be possible that
most MPD patients
have been created in the therapist's laboratory, so to speak? How could it be possible
that so many people, particularly female people [85% of MPD patients are
female], could have so many false memories of childhood sexual abuse? How could so
many people behave as if their bodies have been invaded by numerous entities or
personalities, if they hadn't really been so invaded? How could so many
people actually experience past lives under hypnosis, a standard procedure
of some therapists who treat MPD? How could the defense mechanism
explanation for MPD, in terms of repression of childhood sexual
trauma and dissociation, not be correct? How could so many people be so wrong about
so much? Spanos' answer makes it sound almost too easy for such a massive amount of self-deception and delusion to develop: it's happened before
and we all know about it. Remember demonic possession?

Most educated people today do not try to explain epilepsy, brain damage, genetic
disorders, neurochemical imbalances, feverish hallucinations, or troublesome behavior by
appealing to the idea of demonic possession. Yet, at one time, all of Europe and America
would have accepted such an explanation. Furthermore, we had our experts--the priests and
theologians--to tell us how to identify the possessed and how to exorcise the demons. An
elaborate theological framework bolstered this worldview, and an elaborate set of social
rituals and behaviors validated it on a continuous basis. In fact, every culture, no
matter how primitive and pre-scientific, had a belief in some form of demonic possession.
It had its shamans and witch doctors who performed rituals to rid the possessed of their
demons. In their own sociocognitive contexts, such beliefs and behaviors were seen as
obviously correct, and were constantly reinforced by traditional and customary social
behaviors and expectations.

Most educated people today believe that the behaviors of witches
and other possessed persons--as well as the behaviors of their tormentors, exorcists, and
executioners--were enactments of social roles. With the exception of religious
fundamentalists (who still live in the world of demons, witches, and supernatural magic),
educated people do not believe that in those days there really were witches, or that
demons really did invade bodies, or that priests really did exorcise those demons by their
ritualistic magic. Yet, for those who lived in the time of witches and demons, these
beings were as real as anything else they experienced. In Spanos' view, what is true of
the world of demons and exorcists is true of the psychological world filled with phenomena
such as repression of childhood sexual trauma and its manifestation in such disorders as
MPD.

Spanos makes a very strong case for the claim that "patients learn to
construe themselves as possessing multiple selves, learn to present
themselves in terms of this construal, and learn to reorganize and elaborate
on their personal biography so as to
make it congruent with their understanding of what it means to be a multiple."
Psychotherapists, according to Spanos, "play a particularly important part in the
generation and maintenance of MPD." According to Spanos, most therapists
never see a single case of MPD and some therapists report seeing hundreds of cases each
year. It should be distressing to those trying to defend the integrity of psychotherapy
that a patient's diagnosis depends upon the preconceptions of the therapist. However, an
MPD patient typically has no memory of sexual abuse upon entering therapy. Only after the
therapist encourages the patient do memories of sexual abuses emerge. Furthermore, the
typical MPD patient does not begin manifesting "alters" until after
treatment begins (Piper 1998). MPD therapists counter these charges by claiming
that their methods are tried and true, which they know from experience, and
those therapists who never treat MPD don't know what to look for.*

Multiple selves exist, and have existed in other cultures, without being related to the
notion of a mental disorder, as is the case today in North America. According to Spanos,
"Multiple identities can develop in a wide variety of cultural contexts and serve
numerous different social functions." Neither childhood sexual abuse nor mental
disorder is a necessary condition for multiple personality to manifest itself. Multiple
personalities are best understood as "rule-governed social constructions." They
"are established, legitimated, maintained, and altered through social
interaction." In a number of different historical and social contexts, people
have learned to think of themselves as "possessing more than one identity or self,
and can learn to behave as if they are first one identity and then a different
identity." However, "people are unlikely to think of themselves in this way or
to behave in this way unless their culture has provided models from whom the rules and
characteristics of multiple identity enactments can be learned. Along with providing rules
and models, the culture, through its socializing agents, must also provide legitimation
for multiple self enactments." Again, Spanos is not saying that MPD
does not exist, but that the standard model of (a) abuse, (b) withdrawal
of original self, and then (c) emergence of alters, is not needed to explain MPD. Nor is the
psychological baggage that goes with that model: repression, recovered
memory of childhood sexual abuse, integration of alters in therapy. Nor are the standard
diagnostic techniques: hypnosis, including past
life regression, and Rorschach tests.

It should be noted that books and films have had a strong influence on
the belief in the nature of MPD, e.g., Sybil, The Three Faces of Eve, The Five of Me, or The
Minds of Billy Milligan. These mass media presentations influence not only the general
public's beliefs about MPD, but they affect MPD patients as well. For example, Flora Rheta
Schreiber's Sybil is the story of a woman with sixteen personalities allegedly
created in response to having been abused as a child. Before the publication of Sybil
in 1973 and the 1976 television movie starring Sally Fields as Sybil, there had been only
about 75 reported cases of MPD. Since Sybil there have some 40,000 diagnoses of
MPD, mostly in North America.

Sybil has been identified as Shirley Ardell Mason, who died of breast
cancer in 1998 at the age of 75. Her therapist has been identified as Cornelia Wilbur,
who died in 1992, leaving Mason $25,000 and all future royalties from Sybil.
Schreiber died in 1988. It is now known that Mason had no MPD symptoms before therapy with
Wilbur, who used
hypnosis and other suggestive techniques to tease out the so-called
"personalities." Newsweek (January 25, 1999) reports that, according to
historian Peter M. Swales (who first identified Mason as Sybil), "there is strong
evidence that [the worst abuse in the book] could not have happened."

Dr. Herbert Spiegel, who also treated "Sybil", believes
Wilbur
suggested the personalities as part of her therapy and that the patient adopted them with
the help of hypnosis and sodium pentothal. He describes his patient as highly hypnotizable
and extremely suggestible. Mason was so helpful that she read the literature on MPD,
including The Three Faces of Eve. The Sybil episode seems clearly to be
symptomatic of an iatrogenic disorder. Yet, the Sybil case is the paradigm
for the standard model of MPD. A defender of this model, Dr.
Philip M. Coons, claims that
"the relationship of multiple personality to child abuse was not
generally recognized until the publication of Sybil."

The MPD community suffered another serious attack on its
credibility when Dr. Bennett Braun, the founder of the International Society
for the Study of Disassociation, had his license suspended over allegations
he used drugs and hypnosis to convince a patient she killed scores of people
in Satanic rituals. The patient claims that Braun convinced her that she had
300 personalities, among them a child molester, a high priestess of a
satanic cult, and a cannibal. The patient told the Chicago Tribune: "I
began to add a few things up and realized there was no way I could come from
a little town in Iowa, be eating 2,000 people a year, and nobody said
anything about it." The patient won $10.6 million in a lawsuit against
Braun, Rush-Presbyterian-St. Luke's Hospital, and another therapist.

defenders of MPD

The defenders of the MPD/DID standard model of genesis,
diagnosis, and treatment argue that the disease is underdiagnosed because its complexity
makes it very difficult to identify. Dr. Philip M. Coons, who is
in the Department of Psychiatry at the Indiana University School of
Medicine, claims that "there is a professional reluctance to diagnose
multiple personality disorder." He thinks this "stems from a
number of factors including the generally subtle presentation of the
symptoms, the fearful reluctance of the patient to divulge important
clinical information, professional ignorance concerning dissociative
disorders, and the reluctance of the clinician to believe that incest
actually occurs and is not the product of fantasy." Dr. Coons also
claims that demonic possession was "a forerunner of multiple
personality."

Another defender of the standard model of MPD, Dr. Ralph Allison, has posted
his diagnosis of Kenneth Bianchi, the so-called Hillside Strangler, in
which the therapist admits he has changed his mind several times. Bianchi,
now a convicted serial killer serving a life sentence, was diagnosed as
having MPD by defense psychiatrist Jack
G. Watkins. Dr. Watkins used hypnosis on Bianchi and "Steve"
emerged to an explicit suggestion from the therapist. "Steve"
was allegedly Bianchi's alter who did the murders. Prosecution
psychiatrist Martin
T. Orne, an expert on hypnosis, argued successfully before the court that the hypnosis and the
MPD symptoms were a sham.

Allison claims, but offers no evidence, that the controversy over MPD is one
between therapists, who defend the standard model, and teachers, who deny
MPD exists.*
The battle took place in committee when preparing the DSM-IV, he claims.
The teachers won and MPD was removed and DID replaced it. The
DSM-IV
is the current version (1994) of the American Psychiatric Association's Diagnostic
& Statistical Manual of Mental Disorders. It lists 410 mental
disorders, up from145 in DSM-II (1968). The first edition in 1952 listed
60 disorders. Some claim that this proliferation of disorders indicates an
attempt of therapists to expand their market; others see the rise in
disorders as evidence of better diagnostic tools. According to
Allison, MPD was called "Hysterical Dissociative Disorder" in
DSM-II and did not have its own code number. MPD was listed and coded in
DSM-III, but removed in DSM-IV and replaced with DID.

It is possible, of course, that some cases of MPD emerge
spontaneously without input from the MPD community, while other
cases--perhaps most cases--of MPD have been created by therapists with
the cooperation of their patients who have been influenced by authors and
film makers. In either case, the suffering of the person with MPD is
equally pitiable and deserving of our understanding, not derision.

Finally, there are some MPs who
do not consider their condition to be a disorder, and whose main
suffering comes from the thought of what others will think or do if they
find out. They consider just about everything presented above from the
psychiatrists, psychologists, philosophers, and other professionals to be
myths. Like the
fantasizing women in Wilson and Barber's study (1983) of "fantasy-prone
persons," there are many MPs who don't reveal their "secret" for fear
of ridicule and ostracism.

Keenan, Matt. The Devil & Dr. Braun (Bennett G. Braun, M.D., author of The
Treatment of Multiple Personality Disorder, was the founder and
former Medical Director of the Dissociative Disorders Unit [now closed] at
Rush-Presbyterian-St. Luke's Medical Center in Skokie, Illinois. He
founded of the International Society for the Study of Multiple Personality
Disorder, now known as The International Society for the Study of
Dissociation.)

Illinois has moved to discipline a prominent
psychiatrist accused of convincing a patient that she was a child
molester, a cannibal who ate human flesh meatloaf and the high priestess
of a satanic cult.

Depressed after the birth of her second son,
Patricia Burgus sought therapy from Dr. Bennett Braun. Burgus says the
doctor, through repressed-memory therapy, led her to believe among other
things that she possessed 300 personalities and sexually abused her
children.